Intradialytic Hypercapnic Respiratory Failure Managed by Noninvasive Assisted Ventilation

Tovbin, David; Heimer, Dov; Mashal, Abdallah; Degtyar, Pinchas; Avnon, Lone S.

doi:10.1159/000046279

Cited by 8 publications

(16 citation statements)

References 14 publications

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“…Sulfate deficit in dialysis patients has been demonstrated in several studies . As would have been expected, similar observations, including a significant pCO 2 elevation during dialysis, have been described by other groups . It is important, however, to recognize that endogenous acid production is not static.…”

Section: Acid‐base Regulation and Dysregulation In Renal Failuresupporting

confidence: 67%

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Acid‐base alterations in ESRD and effects of hemodialysis

Qian

2017

Seminars in Dialysis

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Acid-base alterations in patients with kidney failure and on hemodialysis (HD) treatment contribute to (1) intradialytic hypercapnia and hypoxia, (2) hemodynamic instability and cardiac arrhythmia, (3) systemic inflammation, and (4) a number of associated electrolyte alterations including potentiating effects of hypokalemia, hypocalcemia and, chronically, soft-tissue and vascular calcification, imparting poor prognosis and mortality. This paper discusses acid-base regulation and pathogenesis of dysregulation in patients with kidney failure. Major organ and systemic effects of acid-base perturbations with a specific focus on kidney failure patients on HD are emphasized, and potential mitigating strategies proposed. The high rate of HDrelated complications, specifically those that can be accounted for by rapid and steep acid-base perturbations imposed by HD treatment, attests to the pressing need for investigations to establish a better dialysis regimen. ----------------------------------------------------------------This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Acid‐base Regulation and Dysregulation In Renal Failuresupporting

confidence: 67%

“…12,14,15 As would have been expected, similar observations, including a significant pCO 2 elevation during dialysis, have been described by other groups. 16,17 It is important, however, to recognize that endogenous acid production is not static. Studies in dogs have shown that acidosis raises HCO 3 À space and alkalosis exerts an opposite effect.…”

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confidence: 99%

Acid‐base alterations in ESRD and effects of hemodialysis

Qian

2017

Seminars in Dialysis

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“…Finally, a slow infusion of bicarbonate can increase pH without significantly elevating PaCO 2 [33]. Intermittent dialysis, which demands high dialysate flow, is known to be related to rising serum CO 2 [10, 19]. On the other hand, a long-term CRRT with a high concentration of bicarbonate (32 mEq/L) has a non-significant effect on PaCO 2 [34].…”

Section: Discussionmentioning

confidence: 99%

“…Sodium bicarbonate infusions shift this equilibrium and generate more dissolved CO 2 . Indeed, sodium bicarbonate infusions have been associated with elevations of the partial pressure of arterial CO 2 (PaCO 2 ) [9] and deterioration of clinical status [10, 11]. …”

Section: Introductionmentioning

confidence: 99%

Effect of continuous dialysis on blood pH in acidemic hypercapnic animals with severe acute kidney injury: a randomized experimental study comparing high vs. low bicarbonate affluent

Romano

Azevedo

Mendes

et al. 2017

ICMx

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Background: Controlling blood pH during acute ventilatory failure and hypercapnia in individuals suffering from severe acute kidney injury (AKI) and undergoing continuous renal replacement therapy (CRRT) is of paramount importance in critical care settings. In this situation, the optimal concentration of sodium bicarbonate in the dialysate is still an unsolved question in critical care since high concentrations may worsen carbon dioxide levels and low concentrations may not be as effective in controlling pH. Methods: We performed a randomized, non-blinded, experimental study. AKI was induced in 12 female pigs via renal hilum ligation and hypoventilation by reducing the tidal volume during mechanical ventilation with the goal of achieving a pH between 7.10-7.15. After achieving the target pH, animals were randomized to undergo isovolemic hemodialysis with one of two bicarbonate concentrations in the dialysate (40 mEq/L [group 40] vs. 20 mEq/L [group 20]). Results: Hemodynamic, respiratory, and laboratory data were collected. The median pH value at CRRT initiation was 7.14 [7.12, 7.15] in group 20 and 7.13 [7.09, 7.14] in group 40 (P = ns). The median baseline PaCO 2 was 74 [72, 81] Despite the increased infusion of bicarbonate in group 40, the blood CO 2 content did not change during the experiment. The 12-h survival rate was higher in group 40 (67% vs. 0, P = 0.032). Conclusions: A higher bicarbonate concentration in the dialysate of animals undergoing hypercapnic respiratory failure was associated with improved blood pH control without increasing the PaCO 2 levels.

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“…On the one hand, insuffi cient kidney-mediated metabolic compensation in hypercapnic patients can increase mortality, 6 making bicarbonate repletion (via dialysis) critically important. On the other hand, over or rapid bicarbonate loading can induce metabolic alkalosis (an acid-base alteration shown to increase mortality in several hospital settings [7][8][9] ), which may trigger worsening CO 2 retention, ushering in acute respiratory acidosis, another potentially lethal condition. As illustrated in our case, correction of acid-base alterations during hemodialysis may not be straightforward.…”

Section: Discussionmentioning

confidence: 99%

Acute hypercapnic respiratory failure associated with hemodialysis

Palacios

Altayeh

Qian

2011

Dialysis & Transplantation

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Patients undergoing hemodialysis are subject to recurrent acid‐base perturbations. Prior to each dialysis treatment, they are relatively acidemic, which is corrected rapidly during dialysis. We report a patient with obesity, obstructive lung disease, and pneumonia who developed acute respiratory failure triggered by an inﬂux of high bicarbonate during dialysis. This case emphasizes that in patients with severely compromised respiratory reserve, a large amount of bicarbonate inﬂux during hemodialysis may cause acute CO2 accumulation and ventilatory distress. An individualized approach with judicious adjustment of the dialysate bicarbonate concentration may be necessary. Dial. Transplant. © 2011 Wiley Periodicals, Inc.

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Intradialytic Hypercapnic Respiratory Failure Managed by Noninvasive Assisted Ventilation

Cited by 8 publications

References 14 publications

Acid‐base alterations in ESRD and effects of hemodialysis

Acid‐base alterations in ESRD and effects of hemodialysis

Effect of continuous dialysis on blood pH in acidemic hypercapnic animals with severe acute kidney injury: a randomized experimental study comparing high vs. low bicarbonate affluent

Acute hypercapnic respiratory failure associated with hemodialysis

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